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Temple Grove Care Home Outstanding

All reports

Inspection report

Date of Inspection: 13 January 2014
Date of Publication: 11 April 2014
Inspection Report published 11 April 2014 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Enforcement action taken

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 13 January 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, were accompanied by a pharmacist and were accompanied by a specialist advisor.

Our judgement

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

The people we spoke with were generally positive about the care and treatment they received. Comments included "Well looked after", "Excellent care and support", "I am looked after well. However one person told us that although they didn't like to complain they were unhappy with the support provided with regard to their mobility.

We looked at the care records for eight people that used the service. Care plans varied in detail and did not always have up to date guidance on how to meet people's needs. One person's care plan had been reviewed monthly and each time was recorded as "Care plan remains relevant”. The last review was on 03/01/14 but did not reflect the fact that this person now received end of life care. This meant that there were no guidelines for how they should be supported with personal, nutritional and continence care in their current condition.

We spoke with one person and observed that their legs were weeping at time of inspection. We asked them about this and they said that they normally had their leg dressings changed every two days and that they should have been re-dressed yesterday. We asked a nurse to redress them which was subsequently done. We looked at the care plan and communication record which showed that their dressings were last changed on 09/01/14 (four days prior to our inspection). Records showed that this person was admitted to Manor Gardens on 22/12/13 and their legs had been dressed every 2 days up until 05/01/13 when it was changed to every four days. The wound management plan provided no guidelines for frequency of dressing changes. We noted that on 05/01/14 a GP had been called as the person was feverish and had a weeping red leg. The lack of a consistent plan for wound management meant that care was not delivered in a way that was intended to ensure people's safety and welfare.

We identified concerns regarding the management of fluids and nutrition. We observed one person had three drinks in their room and a container of thick ‘n’ easy on the side. The drinks had been thickened to different consistencies and the drink in the person's hand had not been thickened at all. A relative told us that this person's drinks had to be thickened because otherwise they coughed a lot. We asked a staff member what consistency the drinks should be at and they replied “It depends which staff have made the drink as people used different amounts.” Other staff also confirmed that the thickness of this person's drinks was “Variable.” We looked at this person's care plan which provided no guidance to staff about how drinks should be prepared. The lack of a consistent management plan in relation to fluid intake placed this person at risk of choking.

We identified a number of concerns in relation to people that had breathing difficulties. We observed one person in the dining room when their tracheostomy became blocked. They had a one to one carer who calmly called for support. Nursing staff attended promptly. However we noted that the suction machine was not in the dining room when needed. We asked the deputy manager about this who stated that it was desirable for a suction machine to be available in the communal areas, but that it had been taken for use on another person and not replaced. They also told us that the person had their own portable suction machine but that this had not been used since their admission on 7/1/14. Daily records showed that this person had used the suction machine on 10/01/14 due to choking and excess secretions. There was no care plan in place for breathing despite this being a primary need for this individual. This meant that there was a lack of planning to deal with foreseeable emergencies.

We identified concerns relating to the management of catheter care. One person had seven catheter changes in three months. Daily records showed this this was mostly due to the catheter becoming blocked. There was no evidence that external support and advice had been sought. This p